Wednesday, 18 July 2012

When the UK Government first decided to provide the human papillomavirus (HPV) vaccine to all girls it was met with opposition from those who claimed that it would 'fuel promiscuity'. Of course this is nonsense and everyone who works in sexual health with young people said so at the time.

Either the vaccinations would be given with no explanation to the girls of the fact that HPV is a sexually transmitted infection in which case most girls would make no connection – either positive or negative – between the vaccine and sexual activity OR – obviously the option we favoured – the vaccination programme would be used as an opportunity to do some sexual health promotion. This work would:

celebrate the fact that this vaccine could prevent the majority of deaths from cervical cancer

encourage girls to have regular pap or 'smear' tests once they are old enough

talk about minimising risk factors for other cancers and the importance of regular breast checks for adult women and testicular checks for men

emphasise that the vaccination does not give them protection against any of the other panoply of STIs or, of course, against pregnancy.

I haven’t found much information about what education or information is being provided alongside the vaccination, but this study suggests that offering and giving the vaccine has NOT changed young women’s sexual behaviour, turned them into wild nymphomaniacs; or caused them to throw their condoms on the bonfire and caution to the wind.

Today this article reports on schools that are not providing the vaccination because ‘their pupils follow strict Christian principles and do not have sex outside marriage’. So, first the vaccination was rejected because it would promote unsafe sexual behaviour and now it is rejected because pupils in some schools don’t need it as they will definitely not have sex outside of marriage.

Even if it was true that girls who commit to chastity in their early teens don’t ever end up having pre-marital or extra-marital sex (clue: it isn’t), it doesn’t take account of the fact that an abstinent girl can be raped, can be coerced into sex, or can marry a man who has previously had sex and is infected with HPV.

1 comment:

This is a great piece, and I'm just trying to keep my thoughts straight on an issue that makes me want to gnash my teeth. Just to throw in a couple of extra thoughts..

The article has thrown up a few of the big pharma conspiracy theorists today. GSK and Gardasil as corporate entities have some unpleasant tactics, that's for sure; but they are fundamentally motivated by health economics. If the products they create can save lives and treatment costs, then that makes them money. The decision to introduce HPV screening in the UK was also a question of health economics, but it was also dependent upon getting widespread coverage of the vaccine. I believe that opt-out on an individual level should be available (some US states got this wrong) because that's an essential component of medical consent. Furthermore, even young girls have shown that they're absolutely able to understand the implications and nature of the HPV vaccine (I did a bit of work on it). However, institutions opting out of it: no way.

And telling them that they're allowed to get it outside of school is no excuse. It needs three doses to be effective: that's three trips to the doctors that the parent needs to organise, in school time no doubt. The reason that this is given in school is to break down access to services as a barrier, and not having that disadvantages the future health of these women.

Back to health economics (which isn't a dirty word: it's what keeps the NHS running. It's just about getting value for money out of use of treatments). The best case scenario is herd immunity against HPV. If we can achieve that, in the future we may be able to change our approach to screening without endangering lives, and wipe out the 70% of cancers that HPV would cause in the current cohort. Entire swathes of people opting out at the whim of institutions endangers the health economic model however. These people aren't just endangering the health of the students in question, but by potentially keeping the virus in circulation they're a danger to the other women who slip through the cracks.

To return to an earlier point, there was a secondary controversial issue during the introduction of the vaccine. Should we tell young women about the nature of the vaccine, or just treat it as another routine school injection? And we saw that yes, they can absorb that information, they can make up their own mind, and no, it isn't going to make them go off and sleep with everyone in sight, or sexualise them, or whatever. A model of consent that treated these women as active decision-makers and sought to provide them with objective information on the vaccine was clearly the way to go; I can't see any argument for allowing the school to make this decision for them.

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